ORDER

1.      This consumer complaint under section 21(a)(i) of the Consumer Protection Act, 1986 (in short, the ‘Act’) is filed alleging deficiency in service in repudiation of the claim filed by the complainant as her husband’s nominee in a Group Credit Protection Plus Insurance policy issued by the opposite party.

2.      The relevant facts of the case according to the petitioner are that the said policy dated 22.06.2012 was for a life cover of Rs 1,00,00,000/- against a premium of Rs 6,96,519.64. The deceased life assured (DLA), Dr P. Phanindranandha Reddy died a sudden but natural death on 10.11.2013. The complainant approached the opposite party for settlement of claim in December 2013 but was informed vide letter dated 14.04.2014 that the claim was repudiated on the ground that pre-existing diseases such as Type 2 Diabetes Mellitus, Hypertension and Obesity were not disclosed  in the proposal form dated 19.06.2012. The complainant’s representation before the Claims Review Committee was also disallowed on 17.06.2014. The complainant is before this Commission with the following prayer:

i.        Direct the Respondent to pay the entire insured sum of one crore rupees to the Complainant along with an interest at the rate of 15% from the date when the claim was first made by the Complainant.

ii.       Direct the Respondent to pay to the Complainant twenty lakh rupees towards compensation for mental harassment and agony.

iii.      Direct the Respondent to pay to the Complainant two lakhs rupees towards litigation costs

iv.      Pass such other order as this Hon’ble Commission deems fit and proper.

3.     The opposite party resisted the complaint by way of written statement.       It was stated that the DLA was a doctor who was aware of his pre-existing illnesses and deliberately withheld their declaration in the proposal/enrolment form while obtaining the insurance policy. As an insurance policy is a contract of uberrima fides or utmost good faith, suppression of material information rendered the policy void ab-initio and was accordingly repudiated. The ‘Declaration of Good Health’ in the enrolment form had declared the DLA as not suffering from pre-existing illnesses such as diabetes, high blood pressure, heart disease or being on medication for the same. It is stated that the non disclosure misled the opposite party who did not undertake detailed investigations before considering the issuance of the policy. The fact of the DLA’s death was conveyed by the complainant on 29.11.2013 and the cause of death mentioned as heart attack on 11.11.2013 at Vijayawada and was certified by Dr G. Sunil Chowdary. As per investigations by the investigator appointed by the opposite party, the death occurred in Hyderabad and the cremation in Vijayawada. The DLA was reported by Dr Sunil Chowdary to have been suffering from diabetes, hypertension and other diseases such as high cholesterol and dyslipidaemic for the last 3 years prior to his death as also certified by him vide letter dated 15.03.2014. Another Dr GVR Murthi had provided prescriptions for the LA for hypertension and diabetes and vide letter dated 17.12.2013 and confirmed treating him since 2011. Pathology reports from Royal Diagnostics, Vijayawada vide letter dated 17.12.2013 enclosing reports dated 06.07. 2011, 08.03.2012 and 20.11.2012 indicated high triglycerides levels. Another doctor, Dr P. Damodar Reddy had on 18.03.2014 certified that the LA was overweight and diabetic since 3 years. As the DLA died due to cardiac arrest, contributing illnesses for which are abnormally high blood sugar levels and hypertension leading to ischemic heart disease the suppression of these facts was significant and therefore the rejection of the claim was justified. The opposite party’s internal Claims Review Committee also rejected the representation of the complainant for this reason. Reliance is placed on the judgments of the Hon’ble Supreme Court in LIC Vs. Asha Goel & Ors. 2001 (1) SCC 162, LIC Vs.